Protection of the Coronary Arteries During Epicardial Radiofrequency Ablation with Intracoronary Chilled Saline Irrigation: Assessment in an In Vitro Model

Thyer, Isaac A.; Kovoor, Pramesh; Barry, Michael A.; Pouliopoulos, Jim; Ross, David L.; Thiagalingam, Aravinda

doi:10.1111/j.1540-8167.2006.00417.x

Cited by 26 publications

(14 citation statements)

References 20 publications

(39 reference statements)

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“…Thyer et al demonstrated that intracoronary irrigation with chilled saline in an in vitro ovine heart model protected the CA endothelium from heat-induced damage and reduced the probability of the ablation lesion extending to the CA during epicardial RFA. 43 Follow-up in vivo animal studies and subsequent trials to assess the safety and efficacy of this technique are needed.…”

Section: Prevention Of Coronary Artery Injury From Rfamentioning

confidence: 99%

Coronary artery pathophysiology after radiofrequency catheter ablation: Review and perspectives

et al. 2011

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Radiofrequency ablation (RFA) has proven to be an effective and safe treatment in patients with ventricular and atrial tachyarrhythmias. Among complications arising after RFA, the incidence of coronary artery (CA) injury is exceedingly low. When CA injury does occur, however, it can be clinically devastating. The proximity of CAs to common ablation sites suggests that the relationship between RFA and CA perfusion pathophysiology is important. While others have described the presentation and outcomes of patients with CA injury after ablation, a review that consolidates the mechanisms of CA injury after RFA has yet to be presented in the cardiology literature. We conducted an extensive literature search of studies published over the past thirty years that relate the biophysics of RFA with CA perfusion pathophysiology and injury. From this, we present a review of the dynamic relationship between RFA and CA perfusion. We describe RFA lesion pathology, mechanisms of CA injury from RFA, and factors that influence lesion formation such as convective cooling and the ‘shadow effect.’ Finally, we summarize methods to mitigate CA injury after RFA and propose new research avenues to optimize lesion formation and safe arrhythmia treatments when tissue is ablated in the vicinity of CAs.

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Section: Prevention Of Coronary Artery Injury From Rfamentioning

confidence: 99%

Coronary artery pathophysiology after radiofrequency catheter ablation: Review and perspectives

et al. 2011

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“…However, coronary artery injury is an ever present risk (especially near the proximal part of the anterior interventricular vein, see figure) and surgery is still necessary in some cases for VT's originating in this region 15. Cryoablation and potential experimental approaches such as cold saline irrigation are likely to aid these approaches to catheter ablation 11, 16, 17…”

Section: Discussionmentioning

confidence: 99%

Catheter Ablation of Idiopathic Ventricular Tachycardia

Vaseghi

Shivkumar

2010

Circ: Arrhythmia and Electrophysiology

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I diopathic ventricular arrhythmias can originate from either the endocardial, midmyocardial, or epicardial regions of the heart. The outflow tracts and basal regions of the ventricle tend to be common locations of origin of these tachycardias. The anatomy of this region of the heart is both fascinating and, at times, challenging from a procedural standpoint. The orientation of the outflow tracts and basal regions allows mapping of ventricular tachycardias (VTs) using multiple anatomic approaches, such as through the coronary vasculature, directly through a percutaneous pericardial approach (transverse sinus), and through the atrial appendages. 1 The intricate relationship of the outflow and basal regions of the ventricles to the coronary vasculature (arteries and veins) provides useful avenues for epicardial mapping and catheter ablation ( Figure). Coronary veins provide endovascular access to the epicardial regions of the ventricles, especially the crucial area between the junction of the great cardiac vein and the anterior interventricular vein (Figure). Article see p 274Coronary sinus venography was first described in the 1960s. 2 Using occlusive venography, the middle cardiac vein, the great cardiac vein (GCV), and the anterior interventricular vein (AIV) usually can be visualized. The GCV, which runs in the posterior interventricular septum, and the AIV, which runs parallel to the left anterior descending coronary artery, allow epicardial access to the anterior basal ventricular surface. Coronary venous mapping has been an attractive option to identify epicardial circuits in structural heart disease ever since surgical studies demonstrated that about 20% of VTs related to posterior and inferior myocardial infarctions had a critical reentrant circuit in the epicardium. In patients with anterior myocardial infarction, access through the GCV and AIV allows mapping of late diastolic potentials over a wide area of the anterior wall without having to access the epicardium percutaneously. 3 Coronary sinus and venous mapping were described by Arruda et al 4 in 1996, and radiofrequency ablation of idiopathic ventricular tachychardia through this approach was described by Stellbrink et al 5 in 1997.The alternative (complementary) approach-percutaneous epicardial access-has certain limitations, especially pericardial bleeding and tamponade. Another limitation is the presence of epicardial fat that can mimic areas of scar due to the registration of low voltage, can introduce an error in the delineation of scar, and may limit lesion formation if the epicardial fat lies between the ablation catheter and the targeted area. With the use of coronary venous mapping, these limitations can be avoided.Idiopathic VTs and ventricular ectopy originate from the basal aspect of the ventricles, which include the left ventricular outflow tract, right ventricular outflow tract (RVOT), pulmonary artery, aortic cusps, aortomitral continuity, 6 and mitral annulus. Recently, ECG analysis of the location of the tachycardia, particularly ou...

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“…To confirm lesion boundary delineation, histology was performed on one subset of samples. A bath of nitro blue tetrazolium (NBT), which has been shown to differentiate viable from non-viable myocardial tissue, was prepared (13) . An ablated sample was bisected mid-lesion and incubated at 35 °C for 20 minutes in the NBT bath.…”

Section: Methodsmentioning

confidence: 99%

Photoacoustic characterization of radiofrequency ablation lesions

et al. 2012

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Radiofrequency ablation (RFA) procedures are used to destroy abnormal electrical pathways in the heart that can cause cardiac arrhythmias. Current methods relying on fluoroscopy, echocardiography and electrical conduction mapping are unable to accurately assess ablation lesion size. In an effort to better visualize RFA lesions, photoacoustic (PA) and ultrasonic (US) imaging were utilized to obtain co-registered images of ablated porcine cardiac tissue. The left ventricular free wall of fresh (i.e., never frozen) porcine hearts was harvested within 24 hours of the animals’ sacrifice. A THERMOCOOL® Ablation System (Biosense Webster, Inc.) operating at 40 W for 30-60 s was used to induce lesions through the endocardial and epicardial walls of the cardiac samples. Following lesion creation, the ablated tissue samples were placed in 25 °C saline to allow for multi-wavelength PA imaging. Samples were imaged with a Vevo® 2100 ultrasound system (VisualSonics, Inc.) using a modified 20-MHz array that could provide laser irradiation to the sample from a pulsed tunable laser (Newport Corp.) to allow for co-registered photoacoustic-ultrasound (PAUS) imaging. PA imaging was conducted from 750-1064 nm, with a surface fluence of approximately 15 mJ/cm2 maintained during imaging. In this preliminary study with PA imaging, the ablated region could be well visualized on the surface of the sample, with contrasts of 6-10 dB achieved at 750 nm. Although imaging penetration depth is a concern, PA imaging shows promise in being able to reliably visualize RF ablation lesions.

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Protection of the Coronary Arteries During Epicardial Radiofrequency Ablation with Intracoronary Chilled Saline Irrigation: Assessment in an In Vitro Model

Abstract: Intracoronary irrigation with chilled saline may protect the coronary artery endothelium from heat-induced damage during epicardial RFA.

Cited by 26 publications

References 20 publications

Coronary artery pathophysiology after radiofrequency catheter ablation: Review and perspectives

Coronary artery pathophysiology after radiofrequency catheter ablation: Review and perspectives

Catheter Ablation of Idiopathic Ventricular Tachycardia

Photoacoustic characterization of radiofrequency ablation lesions

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